Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision
making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED“ and in last week’s episode I answered another question from our readers and the question was
They Gave Lasix To My Dad In The ICU But He Produced Inadequate Urine. Is He At Risk For Pulmonary Oedema?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED“ I want to answer the succeeding questions from one of my clientsPeter as part of my 1:1 consulting and
advocacy service! asking why his Dad’s CPAP machine cannot be directly connected to his trache according to the ICU team?
Title: My Dad in ICU is on regular CPAP machine. Why is the ICU team tell that we cannot connect his trache into the CPAP machine?
“You can also check out previous 1:1 consulting and advocacy session with me and Peter here.”
PART 1
PART 2
PART 3
Peter: Yeah. Alright now, I’ll let you go. I don’t want to hold you-
Patrik: Not at all, not at all. It’s been a pleasure. It’s been a pleasure helping you and let me know when you need to chat again.
Peter: Okay, alright then.
Patrik: Okay.
Peter: You take it easy, now, alright?
Patrik: And you. All the best. You look after yourself. Thank you.
Peter: Yeah, I know, that’s true.
Patrik: Yeah, you-
Peter: Alright, we’ll see you now.
Patrik: Okay, take care. Bye-bye.
Peter: Okay, Patrik. Bye-bye. Bye.
Patrik: Bye-bye.
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Peter: Hello.
Patrik: Hi Peter. It’s Patrik speaking.
Peter: I can hear you now.
Patrik: Okay. I-
Peter: I don’t know what happened. Maybe I’m in a bad area.
Patrik: Ah. I could hear you clearly on Skype then all of a sudden it was gone.
Peter: I know, same here. It was like… I don’t know what happened. Then I could hear you but you couldn’t hear me. I don’t know what happened.
Patrik: Right. Right. Okay. Alright.
Peter: But anyways.
Patrik: Let’s try that and we’ll see how far we go with that. If not, we go back on Skype. Tell me what happened.
Peter: Well, just the fact that they did it, but the fact they recall it.
Patrik: That’s correct.
Peter: They did the tracheostomy and that went okay. No complications. And then today they weaned him off of it and he’s great the last five hours. The last five hours he’s off the machine completely.
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Patrik: Yup, and that’s great.
Peter: Just a little oxygen mask on him with some vaporized oxygen and he’s breathing twenty times a minute. He’s just kind of tired. That’s all.
Patrik: But that’s great.
Peter: Hopefully that’ll… Hopefully he’ll be a little brighter tomorrow.
Patrik: You see that’s-
Peter: It is, isn’t it?
Patrik: And that’s exactly the advantage of a tracheostomy. Most patients can go off the ventilator very quickly. Often within hours which is exactly what happened with your Dad.
Now did he have any… So they did it yesterday, did you say? Not today, yesterday?
Peter: Say it again now.
Patrik: Sorry. I said did they do the tracheostomy?
Peter: I can hear you.
Patrik: Can you hear me? I can hear you.
Peter: They did it yesterday and he’s off of it.
Patrik: Right. And are you sure he was off the Ventilator/ breathing machine overnight as well?
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Peter: No, no, no. He was on it all night. Just today they decided to wean him off it and see how he did.
Patrik: Right. He could-
Peter: What they did is they slowly brought down his Fi02.
Patrik: Yes. Yes. It wouldn’t surprise if for the next few days, he might need some overnight ventilation.
Peter: Yeah.
Patrik: Right.
Peter: They want him to have a good sleep they said.
Patrik: Yes.
Peter: They’re going to put him on some kind of monitor.
Patrik: Right. But it wouldn’t surprise me if they ventilated overnight for the next few days, and then try him off the ventilator overnight as well.
Peter: Yeah. And they said, too, the regular CPAP, it can’t be used with a trache.
Patrik: Why not?
Peter: So they have to-
Patrik: Why not? Why not? No, that’s not true.
Peter: No?
Patrik: That’s not true.
Peter: They said that. That’s what they told me.
Patrik: No. That’s just, excuse my language. That’s just a whole load of crap.
That’s just a whole load of crap.
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Peter: Yeah.
Patrik: Of course, it can be used with a trache. People have CPAP used-
Peter: You attach the hose directly to the trache too.
Patrik: Absolutely, absolutely.
Peter: Yeah.
Patrik: For sure.
Peter: I know.
Patrik: That’s just a whole load of crap.
Peter: What they want to do is… They said that they want to put him on… They want him to go to a rehab.
Patrik: Yeah.
Peter: I have to learn how to use this machine as a CPAP ventilator.
Patrik: Yeah. Yeah. That… Yeah.
Peter: Just in case he needs it, you know?
Patrik: Yeah. And that makes sense. That makes sense. So, from my perspective, even that he had night time ventilation at home. Obviously, there’s a very good chance that they will have night time ventilation in the future with the trache. What type of rehab facility are they talking about? What is it?
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Peter: Like a pulmonary rehab.
Patrik: Okay. And how far away is that and when?
Peter: It’s not too bad.
Patrik: Right. Is it sort of in the vicinity where you are or is it-?
Peter: It’s more of a… It’s really close to where I live.
Patrik: Okay. And how-?
Peter: Within the vicinity.
Patrik: Right. And how quickly do they want to make this happen?
Peter: They’re going to keep him tonight. Maybe over the next couple days they told me.
Patrik: So they really want to move him this quickly, do they?
Peter: Well they said that they want to get him in so they adjusted his CPAP settings. I don’t know. They want to build up his lungs to make him not as tired.
They did the CO2 levels this afternoon too.
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Patrik: Oh yes, for sure. And what are they like? Do you know?
Peter: I didn’t get any results yet. No.
Patrik: Right. Right.
Peter: I mainly called to tell you that things are so far so good.
Patrik: Yeah. Yeah. No. No. They are. I mean I am… Look, my concern from everything that you’re telling me. How mobile is your dad? I mean is he getting out of bed yet?
Peter: No. He needs a wheelchair.
Patrik: Right.
Peter: They had him in a chair today.
Patrik: Okay. That’s good.
Peter: They kept the speed up and that makes him… That doesn’t help him to wake up.
Patrik: Yeah.
Peter: He’s pretty happy in the pool.
Patrik: Right. Right.
Peter: But I don’t put him through… They were telling me you got to be careful because he just had this thing done, and they don’t want to over tax him too much. They want to go slow with him.
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Patrik: I agree going slow. But at the same time, from my perspective, all they need to… They’re doing this at the hospital or at the rehab facility or they need to do it… They need to optimize his rehab. I can’t actually… How more fragile is your dad now compared to when he went to hospital? Do you think he’s way more fragile?
Peter: I don’t know.
Patrik: Right.
Peter: With that thing in his throat, you know. Now when he coughs, you can hear him coughing with the noise coming out of his trache, whereas before with the tube blocking it, he was coughing and coughing. That was kind of scary.
Patrik: Yeah. You wouldn’t have-
Peter: And choking and coughing and you couldn’t hear him.
Patrik: Yeah.
Peter: It was all inside the tube, you know?
Patrik: I understand. How do you feel about him going to the rehab facility? What are your thoughts?
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Peter: I just want to know how to take care of Dad at night when he’s sleeping.
Patrik: Yeah.
Peter: Because they’re telling me that the regular CPAP isn’t good. You can’t connect it directly to the trache.
Patrik: That’s just a whole load of crap. Excuse my language. At the moment, you have the mask at home. So, all you do is you take the mask off and put that circuit onto the trachea. That’s the only difference. You know?
Peter: You would think, you know.
Patrik: Unless, the only thing is some CPAP machines are designed only for non-invasive ventilation. Meaning they’re only designed for mask ventilation, but you got to check that with them.
Peter: You know now that you mention that word. They did mention the word invasive. They said that the CPAP, I think I believe I heard them say what you just said. It’s not for invasive-
Patrik: Okay. Yeah. That could be but in principle… That could be the case. But in principle, there are CPAP machines that you can connect straightaway to a trachea. In principle, it could well be that this particular machine and this particular manufacturer doesn’t provide that solution. But that would be machine specific, not the principle.
Peter: Maybe it’s a special mode you have to select.
Patrik: Yes.
Peter: If you have a trache or not.
Patrik: That’s right. That’s exactly right. What’s the model of this machine, do you know?
Peter: My model is the Resmed S9.
Patrik: Okay. Yeah. I know Resmed. Well I can tell you if you contact Resmed, they will tell you all about it. Resmed is pretty good.
Peter: Right. Anyway, his O2 98, 99, 100
Patrik: Yeah. That’s pretty good.
Peter: Respiration rate 20. Heart rate about… He’s sleeping though but it’s about 67.
Patrik: That’s pretty good. That’s pretty good. Can you tell me what are they predicting? When he goes to rehab, how much longer will he be in rehab? What are they saying?
Peter: I asked that and they said “Everybody’s different. We don’t know.”
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Patrik: Right. Right. How would you feel about… And it’s your decision. But how would you feel about the stay there and then goes home from there?
Peter: Yeah. They said they normally don’t do that. They like to see him more.
Patrik: Yeah. Okay.
Peter: I can see him more and how this works out with the CPAP machine at night-
Patrik: Yes.
Peter: The ventilator at night. We’ll see what they’re going to do and how they set that up for a CPAP upgrade.
Patrik: Absolutely. And from that perspective, I think it might be worthwhile if he goes to rehab first and then goes home.
Peter: I’m going to ask to see if I can stay with him. You can’t pull the cord you know?
Patrik: Yeah. Insurance wise, if he’s going to rehab and all covered, you’re happy with that?
Peter: Well yeah. Blue Cross Medicare covers him for 100 days I was told.
Patrik: Oh okay. And that’s good because I can tell you sometimes I am dealing with people, depending on their insurance, they only get 21 days. But given that your dad is already off the ventilator, 100 days should be more than sufficient, right?
Peter: Yeah.
Patrik: So that’s good. You’re not-
Peter: The veterans’ hospital, I talked with a therapist there that works with veterans, and they said they’re willing to help pay for different things he needs.
Like if he’s going to go home and he needs a machine at home, they were going to buy him one.
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Patrik: Right. Okay.
Peter: I think it’s all Trilogy.
Patrik: Oh Trilogy? Yeah.
Peter: Battery powered, mobile. She said he can take it with him if he goes anywhere.
Patrik: Yeah.
Peter: That seems to be a good thing.
Patrik: Alright, and before hospital admission, was your dad in a wheelchair as well?
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Peter: Yes, He was.
Patrik: So that’s okay.
Peter: I’m glad we don’t have bad things to talk about right now.
Patrik: Sorry.
Peter: I said I’m glad we don’t have bad things to talk about.
Patrik: That’s right. I mean it’s still like your dad is in hospital but at least he’s moving forward.
Peter: Yeah. And that bothers me now, you know?
Patrik: Of course. I mean, yes he’s moving forward. We don’t have bad things to talk about for now, but at the end of the day he will need care and support.
Peter: Probably, a lot yeah.
The 1:1 consulting session will continue in next week’s episode.
Kind Regards
Patrik
